Implementation Of Physical Activity Policies Research Articles

WYO PETe and WAHPERD: Origin, Development, and Successes of a Great Western Alliance

This article describes a successful Wyoming partnership recently developed between the long-standing Wyoming Association for Health, Physical Education, Recreation, and Dance (WAHPERD) and the newly founded Wyoming Physical Education Teaching (WYO PETe) Collaborative. The organization leaders engaged in extended discussion about how this multi-sector partnership could collaborate to offer Wyoming physical educators a range of professional development (PD) opportunities that meets their individual needs and the unique barriers they face. The decision to combine efforts resulted in WAHPERD and WYO PETe expanding PD opportunities at state convention and throughout the year. The partnership also saw multiple inservice physical educators joining with university faculty and graduate students to form a WAHPERD Advocacy Committee to survey Wyoming physical education and physical activity policy implementation and develop advocacy tools and guidance documents for teachers to use in their districts. The partnership also led to an annual WAHPERD hosted student event called Healthy Kids Roundup that empowers middle school students and their teachers to promote health and wellness in their schools.

Breaking Barriers: An Innovative Tool to Assess the National and City-Level Physical Activity Policy Development to Practice Disconnect.

Population-level physical activity increases are improbable without intersectoral collaboration across government levels and sectors to develop and implement physical activity promotion policies. This study aims to provide information about the development of the Interaction between National and Local Government Levels in Development and Implementation of Physical Activity Policies Tool (INTEGRATE PA-Pol). A framework was created to examine the development and implementation of national and subnational physical activity policies and the (mis)alignment between government levels. The work was conducted in 3 phases: (1)a scoping review was carried out to identify local government physical activity promotion policies and instruments for assessing them, (2)an expert group designed 6 questionnaires, and (3)cognitive response testing was employed for validity testing and item modification with a panel of research and policy experts. The INTEGRATE PA-Pol Tool consists of 6 questionnaires assessing how national and subnational governments collaborate to develop and implement physical activity promotion policies. This tool can assist in better understanding the development and implementation of a public policy monitoring system that will allow for benchmarking and priority setting to comprehend how physical activity promotion policies are designed and executed.

S4-3 Protocol for assessing implementation of physical activity policies by national governments using the Physical Activity Environment Policy Index (PA-EPI)

Abstract Purpose The implementation of physical activity policies has been slow and uneven. As a remedy, the World Health Organization has recommended that national policy implementation should be supported with practical tools and guidance. The Physical Activity Environment Policy Index (PA-EPI) is a tool that allows the extent of policy implementation to be assessed. It comprises a list of good practice policy indicators. These are categorized into eight policy domains targeting aspects of the physical activity environment and seven infrastructure support domains for strengthening physical activity policy systems. This protocol provides researchers with guidance on how to use this tool. Project Guided by a protocol developed by the International Network for Food and Obesity / Non-communicable Diseases (NCDs) Research, Monitoring and Action Support (INFORMAS), the PA-EPI protocol. The INFORMAS protocol was modified based on the research teams experience carrying out the first study utilising the PA-EPI tool. A multi-step process is recommended. This process relies upon the identification of two groups of partners: national policymakers and independent stakeholders tasked with the promotion of physical activity directly and/or indirectly. During the early steps of the process the desk-based research is undertaken to identify information about and evidence of physical activity policy implementation- the PA-EPI Evidence Document. This mapped information is presented to the national policymakers to verify that it is valid and comprehensive. Subsequently, the evidence of implementation is presented to the stakeholders who, using a 5-point Likert scale (1-little or none to 5 high), individually rate the extent of policy implementation in practice. These individual ratings are aggregated and a implementation scorecard is generated displaying the extent of implementation of each of the good practice indicators Stakeholder then engage in an expert workshop to review implementation scores, and identify key policy implementation recommendations which are presented to government. Conclusions The process of conducting a policy implementation assessment using the PA-EPI requires the cooperation of several stakeholders as part of a national coalition. It is envisioned that PA-EPI assessments will enable international cross comparison. This will promote learning from international best practice.

O.1.3-2 Development and implementation of physical activity policies at national and subnational levels: a pilot study in Latin American countries

Abstract Purpose National physical activity (PA) policy processes are only beginning to be documented, and the interaction between the actors involved in these processes remains understudied. This study was designed to gain further insights into the policy process (agenda setting, policy formulation, adoption, implementation, evaluation) and the interaction between national and subnational levels. Methods We conducted a pilot study to assess the feasibility and scalability of an instrument to assess the PA policy process as part of the work of the Global Physical Activity Observatory (GoPA!). The instrument was tested in Colombia, Costa Rica, Ecuador, and Mexico, where pilot data were collected in matched pairs of the capital plus one non-capital city among national and subnational policy makers (n = 24), as identified by the GoPA! Country Contacts. Descriptive statistics were calculated to assess perceptions on the influences and interactions across the two levels with respect to PA policy development, implementation, and evaluation. Results Twenty-two (response rate=85.7%) key informants provided data, mostly from the health sector (54.5%), followed by sports (27.3%), education (9.1%), and transport (9.1%) government institutions. Most participants reported that their countries have a current PA policy embedded within a noncommunicable diseases prevention plan (50.0%), other plan (41.7%), or a plan to prevent, manage, or control obesity (8.3%). Respondents at the subnational level rated PA promotion as central (75.0%), while at the national level the role was important but not central (75.0%). Across the five stages of the policy process, national and subnational policy makers reported low-to-little involvement in the other level’s PA policy processes. Conclusions This pilot study demonstrated the feasibility of collecting national and subnational PA policy data across countries with the active collaboration of the GoPA! network Country Contacts. Also, we successfully identified the degree of interaction between government levels throughout the PA policy process. Initial results suggest that engagement between national and subnational levels is suboptimal. Funding Universidad de los Andes, Bogotá, Colombia; University of California San Diego, USA.

S10-3 The Global Observatory for Physical Activity-GoPA! Policy Inventory: Progress and methods

BackgroundIn 2015, GoPA! was launched to monitor progress on Physical Activity (PA) surveillance, policy and research globally. In 2017, the GoPA! started developing a PA Policy Inventory to enable collecting comparable data on PA policy worldwide.MethodsThe instrument was developed in three stages. Stage-1: Critical assessment of the Policy Inventory version 1.0 was based on a review of other policy instruments/frameworks including: Health enhancing physical activity policy audit tool; the monitoring framework from the EU Recommendation on Health-Enhancing Physical Activity Across Sectors; and the Comprehensive Analysis of Policy on Physical Activity framework. Feedback from 14 GoPA! Country Contacts was received in 2017. Additional critical assessment was conducted from February to May 2019, and four PA policy experts drafted the Policy Inventory version 2.0. Stage-2: Open discussions about the Policy Inventory draft took place between May and August 2019 with seven policy experts. Based on the discussions, the draft questionnaire was revised three times to produce the GoPA! Policy Inventory version 2.0. Stage-3: Ten GoPA! Country Contacts provided their feedback on the Inventory version 2.0. The expert team from Stage 2 reviewed the suggestions and incorporated most of them into the GoPA! Policy Inventory version 3.0.ResultsThe GoPA! Policy Inventory version 3.0 contains: (i) a consent form; (ii) three questions about the respondent; and (iii) 20 questions about physical activity and sedentary behaviour policy. It is available in two formats: (i) an online survey in Qualtrics software; and (ii) an interactive Word document. The instrument collects the information related to: (i) national PA plans/policies; (iii) PA policy implementation; (iv) national recommendations on PA; (v) health surveillance or monitoring system that includes measures of PA; (vi) ministries or departments in national governments with an active role in PA promotion; (vii) quantifiable national targets related to PA; and (viii) comprehensiveness and effectiveness of the overall national PA policy.ConclusionsThe instrument will be used to collect policy data for the 2020 GoPA! Country Cards to be launched at ISPAH2020 and, may further be used by PA researchers and policy analysts to monitor, audit, assess, and analyse national PA policies.

Economic evaluation of a multi-strategy intervention that improves school-based physical activity policy implementation

BackgroundInternationally, government policies mandating schools to provide students with opportunities to participate in physical activity are poorly implemented. The multi-component Physically Active Children in Education (PACE) intervention effectively assists schools to implement one such policy. We evaluated the value of investment by health service providers tasked with intervention delivery, and explored where adaptations might be targeted to reduce program costs for scale-up.MethodsA prospective trial-based economic evaluation of an implementation intervention in 61 primary schools in New South Wales (NSW), Australia. Schools were randomised to the PACE intervention or a wait-list control. PACE strategies included centralised technical assistance, ongoing consultation, principal's mandated change, identifying and preparing in-school champions, educational outreach visits, and provision of educational materials and equipment. Effectiveness was measured as the mean weekly minutes of physical activity implemented by classroom teachers, recorded in a daily log book at baseline and 12-month follow-up. Delivery costs (reported in $AUD, 2018) were evaluated from a public finance perspective. Cost data were used to calculate: total intervention cost, cost per strategy and incremental cost (overall across all schools and as an average per school). Incremental cost-effectiveness ratios (ICERs) were calculated as the incremental cost of delivering PACE divided by the estimated intervention effect.ResultsPACE cost the health service provider a total of $35,692 (95% uncertainty interval [UI] $32,411, $38,331) to deliver; an average cost per school of $1151 (95%UI $1046, $1236). Training in-school champions was the largest contributor: $19,437 total; $627 ($0 to $648) average per school. Educational outreach was the second largest contributor: $4992 total; $161 ($0 to $528) average per school. The ICER was $29 (95%UI $17, $64) for every additional minute of weekly physical activity implemented per school.ConclusionPACE is a potentially cost-effective intervention for increasing schools implementation of a policy mandate. The investment required by the health service provider makes use of existing funding and infrastructure; the additional cost to assist schools to implement the policy is likely not that much. PACE strategies may be adapted to substantially improve delivery costs.Trial registrationAustralia New Zealand Clinical Trials Registry ACTRN12617001265369; Prospectively registered 1st September 2017 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373520

The understanding, application and influence of complexity in national physical activity policy-making

BackgroundComplexity theory and systems-thinking are increasingly popular in physical activity (PA) research and policy discourse. The impact of this perspective shift, across many sectors, may be underwhelming. We explore why, by focusing on how these concepts are understood and applied by PA policy-makers. This is of particular interest given the challenges of multisectoral interest and poorly defined stakeholder boundaries that are associated with PA promotion. In this study, we critique key elements of complexity theory and consider how it is understood and put into practice in PA policy-making.MethodsWe adopted a complex realist position. Ten semi-structured interviews were conducted with national-level policy-makers from United Kingdom government settings (five civil servants, three politicians, two policy advisors). An inductive thematic analysis was conducted, and managed with NVivo 10 software.ResultsThree overarching themes were constructed to reflect policy-makers’ uncertainty about complexity and the application of such perspectives to this policy space, their sense that PA was an unexceptionable yet unclaimed policy issue, and their desire for influence and change. Participants discussed complexity in contrasting ways. Its meaning was context-dependent and dynamic, which generated uncertainty about applying the concept. Participants also perceived an increasingly diverse but ill-defined PA policy system that spans the domains of expertise and responsibility. Collaborative practices may contribute to a previously unobserved sense of detachment from the systems’ complexity. Nevertheless, participants suggested potentially effective ways to stimulate system change, which require passionate and enterprising leadership, and included varied evidence use, a focus on localised implementation and different ways to connect people.ConclusionsThis research highlighted the importance of extending complexity theory and systems-thinking. While emphasizing the prevalence of these ideas across the PA sector, there is uncertainty as to their meaning and implications. This may prevent their use in ways that enhance PA policies and programmes. Participants conceptualised PA as a tool, which was imposed on the system. While this may support participative decision-making and localised implementation, further research is needed to understand how local systems foster leadership, the practical application of complexity and systems-thinking, and how to support system-wide change in the development and implementation of PA policies.

Educators' Barriers and Facilitators to Physical Activity Policy Implementation in the Childcare Setting: Qualitative Findings From the Play Active Project.

We explored childcare educators' perceived barriers and facilitators to policy implementation in order to inform the development and implementation of an early childhood education and care (ECEC) specific physical activity policy. This study was part of the Play Active (2019-2023) project which aimed to develop, implement and evaluate evidence-based physical activity policy to improve physical activity levels in children attending ECEC. Stakeholder focus groups. Setting: ECEC centers in Perth, Western Australia. Sample: Educators (n=66) from 11 ECEC centers participated in 13 focus groups (August-September 2019). Semi-structured questions explored educators' perceptions of barriers and facilitators to implementing a new physical activity policy. A qualitative descriptive approach within a naturalistic framework informed data analysis. Focus group data were reviewed and grouped through several iterations to produce core themes. Four core themes resulted from focus groups: (1) leadership; (2) educator mindset: (3) parent engagement; and (4) organisational and educator capacity. Educators needed supportive leadership and a commitment of resources for physical activity policy implementation. Educators acknowledged physical activity practices can be influenced by knowledge, attitudes, beliefs and change capacity and stressed the need for parent engagement for successful implementation. Educators' voices are important for informing implementation of physical activity policy and practices leading to improvements in children's physical activity levels.

Evaluating the effectiveness of the Play Active policy intervention and implementation support in early childhood education and care: a pragmatic cluster randomised trial protocol

BackgroundDaily physical activity is critical during the early years of life for facilitating children’s health and development. A large proportion of preschool children do not achieve the recommended 3 h of daily physical activity. Early childhood education and care (ECEC) services are a key setting to intervene to increase physical activity. There is a significant need for ECEC specific physical activity policy, including clearer guidelines on the amount of physical activity children should do during care, and strategies for implementation of these guidelines.MethodsThis study is a pragmatic cluster randomised trial to evaluate the effectiveness of the Play Active physical activity policy intervention to improve early childhood education and care educator’s physical activity-related practices. The central component of Play Active is an evidence-informed physical activity policy template which includes 25 practices to support nine age-specific recommendations on the amount of physical activity and sedentary time, including screen time, young children should do while in care. There are six implementation support strategies to facilitate physical activity policy implementation: (i) personalise policy (services select at least five of the 25 practices to focus on initially); (ii) policy review and approval; (iii) a resource guide; (iv) a brief assessment tool for monitoring children’s energetic play; (v) professional development; and (vi) Project Officer implementation support (phone calls). A total of 60 early childhood education and care services will be recruited from metropolitan Perth, Western Australia. After baseline assessment, services will be randomly allocated to either intervention or wait-listed comparison conditions. Primary (educator-reported frequency and amount of daily time provided for children’s physical activity, sedentary and screen time) and secondary (educator physical activity-related practices, self-efficacy, motivation, attitudes and beliefs, social support, and supportive physical environment) outcomes will be assessed at baseline and post-intervention, after intervention services have had a minimum 3 months of policy implementation within their service.DiscussionThe Play Active trial will rigorously evaluate a novel physical activity policy intervention with implementation support that promotes positive physical activity behaviours in educators and children attending ECEC. If effective, the program could be adapted, scaled-up and delivered in ECEC services nationally.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12620001206910 (date of registration 13/11/2020).

Development of physical activity policy and implementation strategies for early childhood education and care settings using the Delphi process

BackgroundThe aim of this study was to gain consensus on an evidence informed physical activity policy template for early childhood education and care (ECEC) and determine best-practice dissemination and implementation strategies using the Delphi process.MethodsThree-round modified Delphi methodology. During round one an expert working group developed an evidence informed ECEC specific physical activity policy template. Rounds two and three involved national online surveys to seek insight from a group of experts on the draft physical activity policy template.ResultsNinety per cent of experts reported ECEC services are fully responsible for having a physical activity policy. There was consensus on the components of the policy and key physical activity and sedentary behaviour statements and recommendations. The most effective methods for disseminating a physical activity policy to ECEC providers included online (websites, social and electronic media), ECEC targeted launch events, direct mail outs and via professional associations. Twenty five key strategies related to management, supervisors and educators; the ECEC physical environment; communicating with families; and accreditation, monitoring and review, were identified as necessary for the successful implementation of physical activity policy in ECEC. Experts reached consensus on nine of these strategies indicating they were both easy to implement and likely to have a high level of influence. Key barriers and enablers to implementing ECEC-specific physical activity were also identified.ConclusionsThis evidence informed physical activity policy template for ECEC provides recommendations on the amount of physical activity and sedentary time (including screen time) children should have whilst attending ECEC and aligns with national/international guidelines. A number of effective physical activity policy implementation strategies for ECEC were identified. An important next step is advocating for the introduction of legislative requirements for services to have and implement a physical activity policy.

Club Fit: Development of a Physical Activity and Healthy Eating Intervention at a Boys & Girls Club After School Program.

Children and adolescents from minority and low income backgrounds face social and environmental challenges to engaging in physical activity and healthy eating to maintain a healthy weight. In this study, we present pilot work to develop and implement a multi-component physical activity and healthy eating intervention at a Boys & Girls Club (BGC) afterschool program. Using a community-based participatory approach, BGC staff and academic researchers developed intervention components informed by formative studies and based on a Social Ecological Theory framework. Components included healthy eating and physical activity policy implementation, staff training, a challenge and self-monitoring program for healthy behaviors, a peer-coaching program for healthy behaviors, and a social marketing campaign. We assessed pilot feasibility through a single group, pre-post study design with measures collected at baseline and 6months. The sample included 61 children with a mean age of 10.4years. Mean (SD) body mass index (BMI) percentile was 72.8 (28.9); 47.5% were in the healthy weight range for their age. We found statistically significant improvements of self-efficacy and motivation for physical activity. Self-efficacy and motivation for fruit and vegetable consumption, sugary beverage consumption, and screen time improved but were not statistically different from baseline. We found no improvements of perceived social support, objectively measured physical activity, or self-reported dietary quality. Though BMI did not improve overall, a dose effect was observed such that attendance in Club Fit specific programming was significantly correlated with decreased BMI z scores. Processes and products from this study may be helpful to other communities aiming to address childhood obesity prevention through afterschool programs.

Implementing School-Based Policies to Prevent Obesity: Cluster Randomized Trial

Healthier school environments can benefit students, and school wellness policies may result in meaningful enhancements. Schools participating in federal child nutrition programs must implement wellness policies as mandated by law. The primary study objective is to assess effectiveness of implementing school-based nutrition and physical activity policies on student BMI trajectories. Cluster randomized trial using 2 × 2 factorial design. Twelve randomly selected schools in an urban district. Students were followed for 3 years through middle school, fifth to eighth grades (2011-2015, n=595 students, 92.3% participation, 85.2% retention). Specific to randomized condition, support was provided for implementation of nutrition policies (e.g., alternatives to food-based rewards/celebrations) and physical activity policies (e.g., opportunities for physical activity during/after school). Sex-/age-adjusted BMI percentile and BMI z-score; behavioral indicators. Data collected via standardized protocols. Analyses followed intention-to-treat principles, with planned secondary analyses (conducted 2016-2018). Students at schools randomized to receive support for nutrition policy implementation had healthier BMI trajectories over time (F=3.20, p=0.02), with a greater magnitude over time and cumulatively significant effects 3 years post-intervention (β=-2.40, p=0.04). Overall, students at schools randomized to receive the nutrition intervention had an increase in BMI percentile of <1%, compared with students in other conditions, whereas BMI percentile increased 3%-4%. There was no difference in student BMI between those in schools with and without physical activity policy implementation. Examining behavioral correlates in eighth grade, students at schools randomized to the nutrition condition consumed fewer unhealthy foods and sugar-sweetened beverages, and ate less frequently at fast-food restaurants (all p<0.03). This cluster randomized trial demonstrated effectiveness of providing support for implementation of school-based nutrition policies, but not physical activity policies, to limit BMI increases among middle school students. Results can guide future school interventions. This study is registered at www.clinicaltrials.gov NCT02043626.

Promoting health-enhancing physical activity in Europe: Current state of surveillance, policy development and implementation

This study aims to present information on the surveillance, policy developments, and implementation of physical activity policies in the 28 European Union (EU) countries.Data was collected on the implementation of the EU Recommendation on health-enhancing physical activity (HEPA) across sectors. In line with the monitoring framework proposed in the Recommendation, a questionnaire was designed to capture information on 23 physical activity indicators.Of the 27 EU countries that responded to the survey, 22 have implemented actions on more than 10 indicators, four countries have implemented more than 20 indicators, and one country has fully addressed and implemented all of the 23 indicators of the monitoring framework.The data collected under this HEPA monitoring framework provided, for the first time, an overview of the implementation of HEPA-related policies and actions at the national level throughout the EU. Areas that need more investment are the “Senior Citizens” sector followed by the “Work Environment”, and the “Environment, Urban Planning, and Public Safety” sectors. This information also enabled comparison of the state of play of HEPA policy implementation between EU Member States and facilitated the exchange of good practices.

Barriers and facilitators to the implementation of a school-based physical activity policy in Canada: application of the theoretical domains framework

BackgroundIn British Columbia Canada, a Daily Physical Activity (DPA) policy was mandated that requires elementary school teachers to provide students with opportunities to achieve 30 min of physical activity during the school day. However, the implementation of school-based physical activity policies is influenced by many factors. A theoretical examination of the factors that impede and enhance teachers’ implementation of physical activity policies is necessary in order to develop strategies to improve policy practice and achieve desired outcomes. This study used the Theoretical Domains Framework (TDF) to understand teachers’ barriers and facilitators to the implementation of the DPA policy in one school district. Additionally, barriers and facilitators were examined and compared according to how the teacher implemented the DPA policy during the instructional school day.MethodsInterviews were conducted with thirteen teachers and transcribed verbatim. One researcher performed barrier and facilitator extraction, with double extraction occurring across a third of the interview transcripts by a second researcher. A deductive and inductive analytical approach in a two-stage process was employed whereby barriers and facilitators were deductively coded using TDF domains (content analysis) and analyzed for sub-themes within each domain. Two researchers performed coding.ResultsA total of 832 items were extracted from the interview transcripts. Some items were coded into multiple TDF domains, resulting in a total of 1422 observations. The most commonly coded TDF domains accounting for 75% of the total were Environmental context and resources (ECR; n = 250), Beliefs about consequences (n = 225), Social influences (n = 193), Knowledge (n = 100), and Intentions (n = 88). Teachers who implemented DPA during instructional time differed from those who relied on non-instructional time in relation to Goals, Behavioural regulation, Social/professional role and identity, Beliefs about Consequences. Forty-one qualitative sub-themes were identified across the fourteen domains and exemplary quotes were highlighted.ConclusionsTeachers identified barriers and facilitators relating to all TDF domains, with ECR, Beliefs about consequences, Social influences, Knowledge and Intentions being the most often discussed influencers of DPA policy implementation. Use of the TDF to understand the implementation factors can assist with the systematic development of future interventions to improve implementation.

Challenges of being new to Canada: considerations for physical activity.

Immigrants to Canada are less likely to be physically active compared with non-immigrants, and the interrelations between personal and environmental factors that influence physical activity for immigrants are largely unexplored. The goal of this qualitative descriptive study was to understand how the experience of being new to Canada impacts opportunities and participation in physical activity. Two focus group interviews with immigrants to Canada were conducted. The first group ( n=7) included multicultural health brokers. The second group ( n=14) included English as a second language students. Qualitative content analysis was used to determine three themes consistent with the research question: transition to Canadian life, commitments and priorities, and accessibility. Discussion was framed using a social ecological model. Implications for practice and policy are suggested including enhanced community engagement, and organizational modifications. Overall, the development and implementation of physical activity policies and practices for newcomers to Canada should be centered on newcomers' perspectives and experiences.